Basic Information
| Provider Information | |||||||||
| NPI: | 1881720175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURNSIDES COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 N 2ND ST | ||||||||
| Address2: | PO BOX 219 | ||||||||
| City: | MARSHALL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624411010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178262358 | ||||||||
| FaxNumber: | 2178262367 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624411010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178262358 | ||||||||
| FaxNumber: | 2178262367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEDSKER | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2178262358 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.